Will Plan to Expand Cardiac Services in NJ Mean that Small Hospitals Lose Out?

Some skeptics worry that new angioplasty legislation would favor large providers over smaller community operators

New legislation to expand access to angioplasty has raised concerns from some providers who have long advocated for such a change, but fear they would not be eligible under a proposal they said favors large systems over community hospitals.

But these worries didn’t stop the Assembly health committee from approving the Democratic legislation, which would require the state to license select hospitals that sought to expand their cardiac catheterization practice by offering both emergency and elective angioplasty — a lucrative and potentially life-saving procedure that can help prevent heart attacks, strokes, and other cardiovascular troubles.

The proposal, introduced two weeks ago by Assembly Speaker Vincent Prieto (D-Hudson) and Senate Budget Chairman Paul Sarlo (D-Bergen), advanced Monday amid a flurry of lame-duck legislative activity. But sources said the measure — which appears to benefit Hackensack Meridian Health, a Bergen-County based system, among other hospital networks — is unlikely to get traction in the Senate, where it awaits a hearing. Both houses have until January 9, the last day of the current session, to take action.

Big versus small

“This bill, I mean no disrespect, would just continue the politics around this (issue) that has just gone on too long,” said Leslie Hirsch, the interim CEO of St. Peters Healthcare System, a small hospital group based in New Brunswick that has served the region for over a century. With a growing number of policies that favor large networks, Hirsch said, “it’s more important than ever that our hospitals be treated fairly.”

For nearly two decades, leaders at a handful of independent community hospitals have pushed the state Department of Health to permit additional qualified facilities to perform both emergency and elective angioplasty. Currently, 29 facilities are licensed to perform a full range of treatments, but these are clustered in the state’s more populous counties; seven rural counties have no hospitals licensed to do both. A process to update the regulations has dragged on for years, some hospitals have complained.

A Republican bill designed to expand angioplasty services in rural areas where it is now limited had a hearing in June, but has not been posted for a vote by Democratic leaders in the Legislature. Sen. Christopher “Kip” Bateman (R-Hunterdon), who introduced the measure in late 2016, said he will try again to move the bill in the next legislative session if the issue is not resolved soon.

It is not clear how the Democratic legislation, as drafted, would benefit the more rural community providers, like Hunterdon Medical Center, that have long advocated for expansion. Hunterdon recently opened a $17 million cardiac catheterization suite and performs hundreds of diagnostic and emergency angioplasties annually, but must refer less urgent “elective” angioplasty patients to Morristown Medical Center, nearly an hour away, under state regulation.

‘It’s just not right’

Under the current system, “we add cost, we add risk and we add inconvenience” for the patient, explained Dr. Glen Tonnessen, the director of cardiac surgery at Hunterdon. “It’s just not right.”

The new bill (A-5267), co-sponsored by Assemblywoman Angelica Jimenez (D-Hudson), would require the DOH to approve elective angioplasty licenses for “mentee hospitals” that are part of a larger network, as long as a “mentor hospital” in the system is currently permitted to offer all aspects of the treatment, or can demonstrate certain competency in the procedure.

Expanding access to elective angioplasty at these hospitals “advances access to care for New Jersey consumers and the delivery of high quality care,” the measure reads. Prieto did not respond to a request for additional information on the goals and intent of the bill.

Several hospital leaders eager to expand access to angioplasty said Prieto’s plan was the wrong approach. Dr. Kristopher Young, a cardiologist who spearheaded several cardiac-care programs at Capital Health, a small Trenton-based hospital group, said the state should enable all qualified hospitals to “prove their ability,” not restrict the pool to facilities that are part of large networks.

“While we support updating New Jersey’s cardiac catheterization regulations,” Dr. Jack Dworkin, a cardiologist at CentraState Healthcare System, in Monmouth County, said he was “not in favor of driving such healthcare policy by legislation that effectively limits care in our community.”

Several hospital leaders said a policy change regarding angioplasty services should really come from the DOH, not lawmakers, although the slow pace of the process frustrates them.

The state expanded angioplasty services to include hospitals that participated in a landmark 2010 safety study on the practice, and extended this agreement in 2015. (The decision added 11 hospitals to a list of 18 already licensed to perform the procedure.) A department representative said Monday that officials are working with the state’s Cardiovascular Health Advisory Panel to develop new regulations.